Prostate Cancer – Diagnosis and Treatments

When my best friend Kurt phoned me with the news that he had prostate cancer, I felt for him but honestly wasn’t all that surprised. It just seemed inevitable that, among my circle of friends, as we headed into our 60s, problems with our prostate gland would surface. So many men suffer from an enlarged prostate as they age that it seemed nearly as inevitable as hearing loss.

Prostate cancer could be considered the male equivalent of breast cancer for women. They’re both all-too common. Their risk significantly increases with age. They are the most common forms of cancer for their respective sexes in the developed world. And survivors often feel sexually inadequate.

Kurt’s case — and James’

“I always had an enlarged prostate and bladder issues,” Kurt told me. A few years ago, a regular check-up revealed a 5.4 P.S.A. When the level didn’t go down, he was sent to a urologist who gave him some medication and did a biopsy. He was told he had cancer a week later: “I went into shock when I heard the C word.”

“We think it may be self-contained but ‘vigorous,’” the urologist told him. After a battery of tests, he submitted to robotic surgery. Although he was only in the hospital overnight, he had to wear a catheter for a week.

For Kurt, there was good news and bad news. “My one issue is that I don’t have complete bladder control,” he says, adding that he has to wear a guard in his underwear for the very occasional leaks. He also has to spend a lot of time in front of the urinal, which he visits frequently.

Now the good news: When he was first diagnosed, an old friend told him that sex was “better than ever.” While Kurt doesn’t go that far, he has had no problems getting aroused. Although he does emit a tiny bit of urine when aroused and he shoots blanks, he has no performance issues. The sensation of an orgasm is just as intense as it ever was — and, he adds jocularly, no cleaning up afterward.

Kurt’s friend James, another cancer survivor, wasn’t so lucky. He has to wear adult diapers; worse, his surgery left him impotent. “He detests the bladder situation,” Kurt related. “He has no choice but to repress his sexuality. He talks about sex nostalgically.”

Detection:

Because they both involve sex organs, prostate cancer, again like breast cancer, was once discussed in low, hushed tones. It was thanks to Viagra that prostate cancer moved from the shadows into the public sphere. Before all of those older men could get their horny hands on the magic pill that would restore their virility, they had to undergo tests on their reproductive system.

As Kurt’s and James’ outcomes demonstrate, even if prostate cancer isn’t a death sentence, it still leaves scars, both physical and psychological. So maybe this is a good place to remind ourselves of the giant strides that have been made in treating it.

The advent of the antigen test known as P.S.A. in the late ‘80s allowed detection far earlier than before and thus stopping the cancer before it can do horrific, even fatal, damage. Still, some argue that P.S.A.’s, which have become ubiquitous in the United States, has resulted in an over-diagnosis and invasive treatment for cancers that might remain benign.

Despite these advances, physicians continue to rely on the tried-and-true method of a hands-on (or, more precisely, in) rectal exam during regular check-ups. It might provide endless fodder for late-night comics, but it invariably produces a shudder among the rest of us.

Treatment:

Because of its high success rate, robotic surgery has become the most sought-after treatment. It’s quick and doesn’t require a lengthy hospital visit.

Those with much smaller tumors can receive brachytherapy, the injection of tiny radioactive particles. But there’s a trade-off; studies have shown that, although incontinence is less of a problem, erectile dysfunction is not uncommon. With all procedures, there’s going to be loss of ejaculation since the prostate is essential in the production of semen.

That’s why for some men, the result may be psychologically debilitating. They probably weren’t considering a late-in-life family. But that doesn’t make it any easier when they realized they couldn’t sire any children. As long as there are men like the late actor Tony Randall, who waited to start a family until he was well into his late 70s, there will be a feeling of loss.

Prostate cancer remains the most common form of the disease among men, which is why it’s such good news that the survival rate in the U.S. has reached 99 percent. Most will, like Kurt, survive and thrive with some minor inconveniences. Others, like James, will experience chronic incontinence and — far worse for the male ego — the end of sex.

Since his operation three years ago, Kurt said, “I’m 100 percent cured. There’s nothing medically wrong with me. But,” he added with a shrug, “I have an old man’s bladder now.” Overall, however, he’s happy. And he has good reason to be: He knows it’s a hell of a lot better to be growing old with some minor irregularities than not to be growing old at all.